Vicki Clarke MS, CCC‐SLP
Disclosures
Financial Disclosure: None
Nonfinancial Disclosure: I offer feedback to AAC device manufacturers including
Dynavox, Tobii and Saltillo as well as numerous AAC app developers, with no
obligation, for review and consideration to include: Tbox Apps, Autismate,
Proloquo2Go, Something to Say, Saltillo, Revolutionary Concepts, Invention Labs,
Bloomingsoft, Mozzaz and Conley Solutions.
Procedures for AAC and Speech
Generating Device Evaluation and
Device Trials
Activity Timeline and Associates Resources
** Underlined items are hyperlinked to on-line resources and forms
Initial 1st Session:
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Meet and Greet! Help the patient get used to the therapist and the environment. A no-pressure
time to get to know the family, look over and complete the initial interview paperwork using the
Dynamic AAC Evaluation Protocol
Review Documentation to Determine Speech, Language and Reading Evaluation Results: If
these are not current, AAC evaluation must include assessment of these skills. If the patient is an
emergent communicator who is not testable using standardized methods, use The
Communication Matrix On-Line Tool to determine communication skills.
Motivation Assessment: Find out motivating activities/items to use in future assessments. Ask
partners for specific, detailed motivators. If motivators are not known for emergent
communicators, may consider doing a motivation assessment such as Every Move Counts, Clicks
and Chats
Session 1-2: AAC Skills Assessment:
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Only if the patient is comfortable and able to tolerate work tasks, begin working through some
of the skills assessment tools:
o SGD Manufacturer’s Downloadable Software: Evaluation Page Sets
 Tobii Communicator Software (evaluation toolkit is included): This software is
functional for 30 days and then goes into evaluation mode which can be used
with patients by connecting a keyboard and entering a key sequence when
prompted periodically
 Prentke Romich PASS Software (matches PRC products and includes an
Exploration Wizard page set)
 NovaChat Editor software: Request DVD from [email protected] (doesn’t
include an evaluation page set)
 Dynavox Semesterware 180 Day Demonstration Software Startup User:
Exploratory Pages and Access Pages (only speaks for 180 days)
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AAC Evaluation Genie App
Test of Aided Symbol Performance (TASP)
This will give you a feel for the patient’s ability to
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understand verbal directions (“touch the ___”)
to match picture to picture
to understand symbol concepts (categorization, associations)
to understand language concepts such as phrase and sentence building, morphology use
etc.
to scan increasingly larger groups of images to locate the requested item
to scan increasingly smaller symbols to locate the requested item
to touch/look at increasingly smaller symbols given only a visual cue (not verbal
direction)
to touch/look at symbols in an increasingly wider area on a page (range of motion)
OR if a scanner, assess understanding of different types of scanning (automatic, 2-switch
step..)
OR if a scanner, assess ability to scan via linear and row/column scanning
OR if a scanner, assess ability to access increasingly small symbols on pages with
increasing number of symbols
What this skills testing will NOT tell you: the patient’s ability to learn to access symbols
through repetition, motor memory for location, and with motivation to acquire desired
items/activities, social rewards etc. Success on these out-of-context drills is NOT a
prerequisite for the use of a speech generating device.
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Determine a list of motivating activities/items to introduce at the next session. Begin mentally
eliminating devices and narrowing down your options keeping physical, sensory and cognitive
skills in mind. Questions to ask yourself:
o Does the patient appear to be able to follow simple directions to “touch” symbols?
o How many button per page does the patient appear to be able to physically access
(either through scanning or direct selection)?
o Does the patient appear to understand basic social interaction? Is s/he responsive to
communication from partners? Does s/he appear to understand communicating for a
variety of functions (requesting, responding, social interaction)? If SO, introduce basic
core word based vocabulary sets (ex: Minspeak, Gateway, WordPower) because the
patient is only learning a new means to communicate. If NOT, consider a pragmatically
organized vocabulary set (ex: PODD- Pragmatically Organized Dynamic Display, Saltillo
MultiChat User) OR context-based (scenes) with simplified vocabulary because you will
be teaching the concept of communication at the SAME TIME you are teaching a new
means to communicate (to an Emergent Level Communicator). Consider initial
simplification needs for emergent users such as hiding buttons and limiting the number
of messages per page.
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Preparation for Sessions 2-4: Customize at least 3 AAC options for the patient to try out.
Customization should include placing highly motivating photographs, videos, or sound effects on the
devices. Highly motivating activities/items should be gathered to present to the patient.
Sessions 2-4 AAC Communication Assessment (Trial Period)
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Introduce motivating activities/highly interesting topics of conversation. Model appropriate use
of the device without pressure to perform. Invite the patient to try out the device following
your model to meet communication functions (requesting, commenting, responding). Offer
suggestions of possible messages the patient could try out. Model navigation to desired
messages. Avoid “show me the __” language for this portion of the assessment. Model and
expect functional, purposeful communication.
Use the Hands On Evaluation Data Sheets to cue you for skills to assess (ex: GPAT Forms or
Dynamic AAC Evaluation Hands On Data sheets- pages 16-30 of the Dynamic AAC Evaluation
Protocol)).
Assess the patient’s ability to remember and reproduce your model for direct communication,
navigation, various functions of language (greeting, commenting, requesting…).
Preparation for Sessions 3-5 Funding Paperwork Generation
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Write the AAC/SGD Evaluation. Use report templates to ensure you use all required terms and
statements.
o Prentke Romich https://eval.prentrom.com/access/login (for Saltillo and Prentke
Romich devices)
o AAC Funding Help: AAC Report Coach
http://www.aacfundinghelp.com/report_coach.html (also in your handout)
o AAC-RERC Medicare Funding of AAC Technology Website http://aacrerc.psu.edu/index.php/pages/show/id/5
o Dynavox Funding Manager Software
http://www.dynavoxtech.com/cdn/downloads/apps/FundingManager_Install_E.exe
Collect copies of all insurance/Medicaid/Medicare cards
Complete Client Information Forms (demographics) from manufacturers’ websites
Request and procure a quote for all equipment (including device and accessories) from the
manufacturer
Complete a Benefits Release form available on most manufacturers’ websites
Request a prescription for all equipment from the patient’s physician. (prescription forms are
often available from the manufacturers and are often in “packets” of information the
manufacturer’s provide) Prescriptions in Georgia have to show the date the physician saw the
patient (within the last 6 months) and have the patients height and weight listed.
Send all paperwork to the manufacturer to be filed with insurance/Medicaid/Medicare
Sessions 3-5 Customization & Implementation Planning
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Request patient and partners in all primary environments (home and work/school) complete
lists of the patient’s favorite people, activities, places, items, food/drinks, leisure activities etc.
Consider asking partners to take photographs of significant people to include on the
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communication pages. Logos for favorite items/community places can be copied from the
internet using image search engines such as Google Image search
http://www.google.com/imghp?hl=en&tab=wi.
Complete the AAC Implementation Worksheets to determine environmental communication
needs and vocabulary/messaging needs. (Handout)
Complete the Dynamic AAC Goals Grid to determine individual skills and needs in competency
areas (Linguistic, Operational, Social and Strategic)
Begin putting custom vocabulary into selected page sets using editing software, if available.
Sessions 6-7 Delivery of Equipment
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Check in all equipment, label each item and load any custom programming.
Assist team in setting up an appointment with sales representatives to do initial equipment
training.
Determine follow up services. For all patients receiving a speech generating device, best
practice is to follow up with weekly therapy and consultation for at least 8 weeks. Monthly
consultation is recommended for the year following receipt of equipment. After the initial year,
biannual or annual visits continue to be indicated to meet changing communication needs.
Duration of services on a weekly basis is dependent on the needs of the patient. Patients with
intact language skills usually require significantly less follow-up services after the initial 6
months. Patients who are learning both communication skills and the techniques of
augmentative communication require significantly longer follow-up services. Younger patients
who are in formative years of language development, learning communication skills
concurrently with augmentative communication skills can receive services for many years to
meet developmental needs.
Special Notes for Evaluating Emergent Communicators:
If you are assessing an emergent communicator, evaluation most likely will begin with the AAC
communication assessment using motivating activities and items. Our favorites include YouTube
videos, wind-up toys, snacks & drinks, balloons & bubbles. You may or may not be able to complete
AAC skills assessment using criterion referenced tools (TASP or AAC Evaluation Genie).
Emergent Communicators have the following characteristics:
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It is often difficult to know if an Emergent communicator always understands his/her
communication partners. Understanding may be impacted by the partner, by context or
by other variables.
Emergent communicators are just beginning to communicate by using a variety of
forms, including gestures, body language, facial expressions, and a few simple and
easily-recognized symbols.
For Emergent communicators, the focus is on communicating basic needs and
beginning social interaction.
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Emergent communicators often require assistance from a communication partner to
help narrow down choices or provide other guidance.
Emergent communicators can relay a limited number of messages in a small set of
specific contexts and routines.
*from A Dynamic AAC Goals Planning Guide, copyright 11/2010, Clarke & Schneider
Emergent Communicators often have difficulties in one or more of the following areas:
- Auditory comprehension
- Symbolic understanding
- Sensory impairment
- Motor planning difficulty
- Cortical visual processing
- Blindness
- Cognitive impairment
When evaluating a patient with any of these difficulties, it is imperative that the patient is provided
with maximum information about the symbol they are accessing and the expected response of the
communication. The evaluator must make sure that the patient is supported in the following ways
to allow him to make use of his strengths:
VISUAL: access to a symbol that has the best visual characteristic for their abilities (size, color,
location);
MOTOR MEMORY: that the symbols, once learned, stay in a static, predictable location (for motor
memory)
AUDITORY: auditory feedback labels the button or gives a predictable phrase message
LEARNING: consistent response from partners every time a message is activated
LEARNING OVER TIME: exposed for a long period of time, in context, before expected mastery
TACTILE SENSITIVITY is not impacted by the physical features of the symbols/buttons/device
(paper, extraneous auditory noises/feedback etc).
Consider: What type of AAC system meets these needs? Can you meet these needs with light
technology?
Consider the demands of the evaluation task you are presenting. When you ask a patient to “touch
the cookie” symbol, are you assessing his ability to recognize the symbol, understand the word
“cookie,” understand the direction “touch” or to visually scan and find the symbol? OR all of these?
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